University of Pittsburgh Medical Center, Affiliates to Pay $2.5M in Whistleblower Lawsuit

The University Of Pittsburgh Medical Center (UPMC) will pay $2.5 million to settle claims in a federal whistleblower lawsuit that accused the hospital network of fraudulent billing and overbilling government insurance programs for neurosurgery. In some cases they were charging for care that was never rendered, according to the suit.

The Justice Department recently reached the agreement with UPMC, which also required three affiliates to pay the $2.5 million to settle civil claims outlined in the whistleblower lawsuit.

UPMC “created a culture where money – not medicine – drove the decision-making process,” the suit said. What the lawsuit didn’t say was how much the overbilling allegedly cost the government programs or how the feds arrived at the settlement amount. However, the lawsuit alleges UPMC was a “repeat offender” with regard to billing for surgeries performed by residents, fellows or assistants when no teaching physician oversaw the procedures.

Stating they would have “vigorously” defended itself had the whistleblower case moved forward, UPMC didn’t admit any liability in the settlement.

These types of cases allow whistleblowers to sue for treble damages, which refers to the recovery of three times the amount of actual financial losses suffered which is provided by statute for certain kinds of cases. And the suit claimed that UPMC improperly billed the government tens of millions of dollars between 2006 and 2015.